Electrocardiographic Correlates of Myocardial Injury After Transcatheter Aortic Valve Replacement.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is associated with several conduction abnormalities and a need for pacemaker placement. The study aim was to describe all electrocardiographic (ECG) changes seen after TAVR, to compare such changes between transapical (TA) and transfemoral (TF) patient cohorts, and to assess their impact on postoperative outcomes.

METHODS: Between March 2009 and July 2014, a total of 286 consecutive patients underwent TAVR at the present authors' institution. Perioperative data were collected prospectively, while preoperative and predischarge electrocardiograms were reviewed retrospectively by an independent cardiologist.

RESULTS: A greater proportion of TA patients experienced ECG changes than TF patients at the time of discharge (78% versus 42%; p <0.0001), with more intraventricular conduction abnormalities (29% versus 15%; p = 0.006), and a trend towards more frequent atrioventricular block and pacemaker placement. Troponin levels were higher in patients with new ECG changes (4.61ng/ml versus 2.12 ng/ml; p = 0.0009). New intraventricular conduction abnormalities were associated with increased one-year mortality only in the TF subgroup (65% versus 84%; p = 0.028). Six TA patients demonstrated new ECG findings of myocardial infarction, and this was associated with greater 30-day mortality (67% versus 98%; p = 0.012), although none met the clinical criteria for myocardial infarction.

CONCLUSIONS: New ECG changes after TAVR, including new conduction abnormalities, were seen more frequently in TA patients. When seen in TF patients, they were associated with decreased survival. ECG findings of new myocardial infarction, seen only in TA patients, were also associated with decreased survival.